Abnormalities in cortical gray matter density in borderline personality disorder

Neurological soft signs and olfactory dysfunction in patients with borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is a serious disorder with a lifetime prevalence of 2.7-5.9% and is thought to correlate with altered neuroplasticity. The aim of the present study is to investigate possible associations of BPD (-severity) and alterations in neurological soft signs (NSS) and olfactory function.

METHODS

For the monocentric observational study, 39 female subjects with a BPD diagnosis and 19 female healthy control subjects were recruited. The groups were matched by age. Olfactory functions were examined using Sniffin' Sticks. NSS were assessed by a standardized test with 50 items.

RESULTS

BPD subjects have higher NSS scores in group comparison. By contrast, there are no alterations in the total score of olfactory function, while the BPD subjects scored higher in smell identification. Within the BPD group, the total NSS score was discovered to have a negative correlation with olfactory function. BPD subjects taking antipsychotics show more NSS than those without. We found no significant influence of posttraumatic stress disorder on the NSS or olfactory function. The BPD-severity correlates with NSS.

LIMITATIONS

Due to the cross-sectional design, we did not have a follow up examination. The sample size was small, and all patients had psychiatric comorbidities. Additionally, we did not perform MRI to connect our findings with possible structural abnormalities.

CONCLUSIONS

Our study confirmed altered NSS in BPD patients, whereas no impairment in the olfactory function was found. Further research is required to establish NSS and smell tests as clinical screening tools in BPD patients and to uncover the disorder's impact on neuroplasticity.

Pathophysiological aspects of complex PTSD - a neurobiological account in comparison to classic posttraumatic stress disorder and borderline personality disorder

Despite a great diagnostic overlap, complex posttraumatic stress disorder (CPTSD) has been recognised by the ICD-11 as a new, discrete entity and recent empirical evidence points towards a distinction from simple posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The development and maintenance of these disorders is sustained by neurobiological alterations and studies using functional magnetic resonance imaging (fMRI) may further contribute to a clear differentiation of CPTSD, PTSD and BPD. However, there are no existing fMRI studies directly comparing CPTSD, PTSD and BPD. In addition to a summarization of diagnostic differences and similarities, the current review aims to provide a qualitative comparison of neuroimaging findings on affective, attentional and memory processing in CPTSD, PTSD and BPD. Our narrative review alludes to an imbalance in limbic-frontal brain networks, which may be partially trans-diagnostically linked to the degree of trauma symptoms and their expression. Thus, CPTSD, PTSD and BPD may underlie a continuum where similar brain regions are involved but the direction of activation may constitute its distinct symptom expression. The neuronal alterations across these disorders may conceivably be better understood along a symptom-based continuum underlying CPTSD, PTSD and BPD. Further research is needed to amend for the heterogeneity in experimental paradigms and sample criteria.

Structural MRI Brain Alterations in Borderline Personality Disorder and Bipolar Disorder

Bipolar disorder (BD) and borderline personality disorder (BPD) share many behavioral features, such as periods of marked affective lability and instability. Although there is a symptomatic overlap, the two disorders may be differentiated based on longitudinal course, phenomenology, and treatment responsiveness. In addition, the emotional changes in BPD are generally influenced by interpersonal factors, whereas BD episodes tend to be more sustained. We performed a literature review on the structural MRI features of both disorders and compared the findings. There are differences in areas of white and gray matter volumes and thickness in BP and BPD. BPD primarily affects the fronto-limbic network, in particular, the amygdala, hippocampus, and orbitofrontal cortex, whereas BP affects both cortical and subcortical areas. There are a limited number of large studies, and many studies examined in this review did not adjust for confounding factors or motion artifacts, which limit the utility of current data.

[Neurobiological principles of borderline personality disorder: integration into the ICD-11 model of personality disorders]

BACKGROUND

Borderline personality disorder (BPD) is a severe mental disorder associated with far-reaching impairments in the self and interpersonal functioning. The broad database has contributed to the fact that BPD remains the only categorical personality diagnosis in ICD-11, even if coupled to the determination of the severity of impairments. Nevertheless, we need to deal with a dimensional conceptualization of personality disorders-which is also supported by neuroscientific findings-at the latest in 2022 when the ICD-11 comes into effect .

OBJECTIVE

This narrative review provides an overview of neuroscientific findings regarding impairments in self and interpersonal functioning in patients with BPD.

RESULTS

Alterations in the medial prefrontal cortex, temporoparietal junction and precuneus mediate deficits in self-referential thought processes and the mentalization of emotions and intentions of others. Enhanced connectivity between the amygdala and midline structures is associated with hypermentalization. At the same time, elevated insula activation seems to underlie the strengthened nonreflective parts of feelings of other people. Frontolimbic alterations are transdiagnostically associated with deficient emotional regulation and negative affectivity and alterations in reward and cognitive control regions are related to impulsivity.

CONCLUSION

Neuroscientific findings help to have a better understanding of the underlying mechanisms of central functional impairments in BPD and can support the transition to ICD-11 as well as the implementation of new interventions.

Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response

Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.

A unified model of shared brain structural alterations in patients with different mental disorders who experience own-thought auditory verbal hallucinations-A pilot study

OBJECTIVE

To explore shared brain structural alterations in patients diagnosed with mental disorders who experience own-thought auditory verbal hallucinations (OTAVHs).

METHODS

A cohort of 143 first-diagnosis, nonmedicated patients with OTAVHs was enrolled: 25 with schizophrenia (FUSCH-OTAVH), 20 with major depression disorder (FUMDD-OTAVH), 28 with bipolar disorder (FUBD-OTAVH), 22 patients with posttraumatic stress disorder (FUPTSD-OTAVH), 21 with anxiety disorder (FUAD-OTAVH), and 27 with borderline personality disorder (FUBPD-OTAVH); 25 healthy controls (HCs) participated. The Auditory Hallucinations Rating Scale (AHRS), multiple psychometric scales, voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and multiple regression were used.

RESULTS

Compared with HCs, patients had increased occipital cortex, dorsal prefrontal cortex (PFC), and striatum gray matter volumes (GMVs), a reduced insular cortex (IC) GMV, and an impaired frontooccipital fasciculus. The following differences were found versus HCs: FUSCH-OTAVH, reduced PFC and occipital GMVs, increased striatum and thalamus GMVs, impaired arcuate fasciculus, u-shaped bundle, optic tract, and upper longitudinal fasciculus (LF); FUMDD-OTAVH, increased posterior frontotemporal junction and hippocampus GMVs; FUMN-OTAVH, increased posterior frontotemporal junction and parietal cortex GMVs, reduced hippocampus GMV, impaired upper LF; FUPTSD-OTAVH, increased temporal, hippocampus, and nucleus accumbens GMVs; FUBPD-OTAVH, increased frontotemporal junction and hippocampus GMVs, impaired upper/lower LF; and FUAD-OTAVH, increased frontal and temporal cortex, hippocampus GMVs.

CONCLUSIONS

The present findings provide evidence consistent with a bottom-up and top-down reciprocal action dysfunction hypothesis of AVHs and with the dopamine hypothesis of AVHs. We observed specific features related to OTAVHs in patients with different mental disorders. The findings, though complex, provide clues for further studies of specific mental disorders.

Unified and disease specific alterations to brain structure in patients across six categories of mental disorders who experience own-thought auditory verbal hallucinations: A pilot study

OBJECTIVE

To explore the unified and disease specific structural features of the brain in patients spanning six mental disorders who experience own-thought auditory verbal hallucinations (OTAVH).

METHODS

A pilot study was conducted on 25 patients with schizophrenia (FUSCH-OTAVH), 20 patients with major depression disorder (FUMDD-OTAVH), 28 patients with bipolar disorder (FUBD-OTAVH), 22 patients with posttraumatic stress disorder (FUPTSD-OTAVH), 21 patients with anxiety disorder (FUAD-OTAVH), and 27 patients with borderline personality disorder (FUBPD-OTAVH). Twenty-five healthy controls (HCs) were also recruited. Auditory Hallucinations Rating Scale (AHRS) multiple psychometric scales were adopted to assess the clinical features of voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and multiple regression in all patients. Common and specific brain features of OTAVH among these mental disorders were investigated.

RESULTS

Compared to HCs, GMV aberrant pattern across all the six categories patients with OTAVH decreased in the occipital cortex, left parietal lobe, prefrontal cortex (PFC), and insular cortex (IC). Aberrant patterns in white matter (WM) were detected in the corpus callosum and impairment of the fronto-occipital fasciculus. Structural differences in the brain were observed for each mental disorder versus HCs.

CONCLUSIONS

The unified brain aberrant features of OTAVH across six mental disorders were characterized by decreased GMV and WM impairments in some regions and the specific brain features of each disease were also characterized. In conclusion, this study provides evidence for the structural basis of OTAVH and potential avenues for investigating disease specific brain features of OTAVH.

Microstructural white matter alterations in borderline personality disorder: A minireview

BACKGROUND

Borderline personality disorder (BPD) affects 1-5% of the population and is characterized by a complex symptomatology and selective functional impairments. Although brain imaging studies have contributed to better characterizing the pathophysiological mechanisms underlying BPD, the white matter (WM) deficits associated with this disorder are still unclear. Therefore, the present review aims at providing an overview of the findings emerged from the available diffusion tensor imaging (DTI) studies on BPD.

METHODS

From a bibliographic research in PubMed until May 2019, we collected 12 studies that fulfilled our inclusion criteria, including a total sample of 291 BPD subjects and 293 healthy controls.

RESULTS

Overall, the DTI studies reviewed showed impairments in selective WM tracts that are part of the prefronto-limbic system, including frontal WM (short and long tracts), anterior cingulate cortex, corpus callosum, corona radiata, hippocampal fornix and thalamic radiation, in BPD patients compared to healthy controls.

LIMITATIONS

Few DTI studies with heterogeneous findings.

CONCLUSIONS

Overall these results reported that BPD is characterized by selective structural connectivity alterations in prefronto-limbic structures, further supporting the neurobiological model of BPD that suggests the presence of an abnormal modulation of frontal regions over limbic structures. Finally, the results also highlighted that the disrupted WM integrity in selective brain regions may also explain key-aspects of BPD symptomatology, including emotional dysregulation, ambivalence, contradictory behaviors and cognitive dysfunctions.

Cortical haemodynamic response measured by functional near infrared spectroscopy during a verbal fluency task in patients with major depression and borderline personality disorder

BACKGROUND

Functional near infrared spectroscopy (fNIRS) provides a direct and quantitative assessment of cortical haemodynamic function during a cognitive task. This functional neuroimaging modality may be used to elucidate the pathophysiology of psychiatric disorders, and identify neurophysiological differences between co-occurring psychiatric disorders. However, fNIRS research on borderline personality disorder (BPD) has been limited. Hence, this study aimed to compare cerebral haemodynamic function in healthy controls (HC), patients with major depressive disorder (MDD) and patients with BPD.

METHODS

fNIRS signals during a verbal fluency task designed for clinical assessment was recorded for all participants. Demographics, clinical history and symptom severity were also noted.

FINDINGS

Compared to HCs (n = 31), both patient groups (MDD, n = 31; BPD, n = 31) displayed diminished haemodynamic response in the frontal, temporal and parietal cortices. Moreover, haemodynamic response in the right frontal cortex is markedly lower in patients with MDD compared to patients with BPD.

INTERPRETATION

Normal cortical function in patients with BPD is disrupted, but not as extensively as in patients with MDD. These results provide further neurophysiological evidence for the distinction of patients with MDD from patients with BPD.

Dysfunction of Empathy and Related Processes in Borderline Personality Disorder: A Systematic Review

After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.

Neurobiological and clinical effect of metacognitive interpersonal therapy vs structured clinical model: study protocol for a randomized controlled trial

BACKGROUND

Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The "gold standard" treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to assess the clinical and neurobiological changes following Metacognitive Interpersonal Therapy (MIT) compared with Structured Clinical Management (SCM) derived from specific recommendations in APA (American Psychiatric Association) guidelines for BPD.

METHODS

The study design is a randomized parallel controlled clinical trial and will include 80 BPD outpatients, aged 18-45 enrolled at 2 recruitment centers. Primary outcome will be the clinical change in emotion regulation capacities assessed with the Difficulties in Emotion Regulation Scale (DERS). We will also investigated the effect of psychotherapy on metacognitive abilities and several clinical features such as BPD symptomatology, general psychopathology, depression, personal functioning, and trait dimensions (anger, impulsivity, alexithymia). We will evaluate changes in brain connectivity patterns and during the view of emotional pictures. A multidimensional assessment will be performed at the baseline, at 6, 12, 18 months. We will obtain structural and functional Magnetic Resonance Images (MRIs) in MIT-Treated BPD (N = 30) and SCM-treated BPD (N = 30) at baseline and after treatment, as well as in a group of 30 healthy and unrelated volunteers that will be scanned once for comparison.

DISCUSSION

The present study could contribute to elucidate the neurobiological mechanisms underlying psychotherapy efficacy. The inclusion of a multidisciplinary study protocol will allow to study BPD considering different features that can affect the treatment response and their reciprocal relationships.

TRIAL REGISTRATION

NCT02370316 . Registered 02/24/2015.

Abnormalities in functional connectivity in borderline personality disorder: Correlations with metacognition and emotion dysregulation

A few studies reported functional abnormalities at rest in borderline personality disorder (BPD), but their relationship with clinical aspect is unclear. We aimed to assess functional connectivity (FC) in BPD patients and its association with BPD clinical features. Twenty-one BPD patients and 14 healthy controls (HC) underwent a multidimensional assessment and resting-state fMRI. Independent component analysis was performed to identify three resting-state networks: default mode network (DMN), salience network (SN), and executive control network (ECN). FC differences between BPD and HC were assessed with voxel-wise two-sample t-tests. Additionally, we investigated the mean FC within each network and the relationship between connectivity measures and BPD clinical features. Patients showed significant lower mean FC in the DMN and SN, while, at the local level, a cluster of lower functional connectivity emerged in the posterior cingulate cortex of the DMN. The DMN connectivity was positively correlated with the anger-state intensity and expression, while the SN connectivity was positively correlated with metacognitive abilities and a negative correlation emerged with the interpersonal aggression. The dysfunctional connectivity within these networks might explain clinical features of BPD patients.

Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering

Objective

To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction.

Method

We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering.

Results

Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles.

Conclusion

Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder

BACKGROUND

There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD.

METHODS

We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time.

RESULTS

We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus.

LIMITATIONS

Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition.

CONCLUSION

We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder

BACKGROUND

There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD.

METHODS

We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time.

RESULTS

We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus.

LIMITATIONS

Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition.

CONCLUSION

We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions.

Hemispheric asymmetry of the frontolimbic cortex in young adults with borderline personality disorder

OBJECTIVE

Although the frontolimbic cortex has been implicated in borderline personality disorder (BPD), information about possible asymmetries in this region in patients with BPD is limited. This study aimed to examine whether frontolimbic cortex asymmetries differ between patients with BPD and healthy individuals.

METHODS

The brains of 30 young adult patients with BPD and 32 healthy control subjects were scanned with magnetic resonance imaging (MRI). The participants completed self-report scales assessing impulsivity, affect intensity and other psychological variables. Gray matter volume, surface area, and cortical thickness in regions of interest (ROIs), namely anterior insula (AI) and anterior cingulate cortex (ACC) were determined and the data were probed for hemisphere-group interactions.

RESULTS

Relative to controls, patients with BPD had reduced cortical thickness in left ACC and less surface area and gray matter volume in left AI. Significant group-hemisphere interactions were observed for gray matter volume and surface area of AI and for cortical thickness of ACC. Post hoc analysis showed that the BPD patients had greater frontolimbic cortex asymmetry than healthy controls; furthermore, greater asymmetry of AI&ACC correlated with a higher score in attention subscale of Barratt Impulsiveness Scale.

CONCLUSION

Patients with BPD have greater frontolimbic asymmetry than healthy individuals.

Neurobiology of Criterion A: self and interpersonal personality functioning

The Criterion A of the DSM-5 Alternative Model of Personality Disorders follows a functional approach to personality disorders which can be effectively related to abnormalities in brain circuits that are involved in processes related to the self and others. While brain circuits related to the self and others highly overlap supporting the notion of inseparable constructs, structural and functional neuroimaging data point to rather specific deviations in brain processes among the various types of personality disorders, with a focus on borderline and antisocial personality disorders. Neurobiological data have shed light on the problem areas of individuals with personality disorders that goes beyond what we know from either patients' reports or observing their behavior and may open new perspectives on treatment.

Event-Related Potentials Altered in Patients with Borderline Personality Disorder during Working Memory Tasks

Whereas some studies have demonstrated impaired working memory (WM) among patients with borderline personality disorder (BPD), these findings have not been consistent. Furthermore, there is a lack of neurophysiological evidence about WM function in patients with BPD. The goal of this study was to examine WM function in patients with BPD by using event-related potentials (ERPs). An additional goal was to explore whether characteristics of BPD (i.e., impulsiveness and emotional instability) are associated with WM impairment. A modified version of the N-back task (0- and 2-back) was used to measure WM. ERPs were recorded in 22 BPD patients and 21 age-, handedness-, and sex-matched healthy controls (HCs) while they performed the WM task. The results revealed that there were no significant group differences for behavioral variables (reaction time and accuracy rate) or for latencies and amplitudes of P1 and N1 (all p > 0.05). BPD patients had lower P3 amplitudes and longer N2 latencies than HC, independent of WM load (low load: 0-back; high load: 2-back). Impulsiveness was not correlated with N2 latency or P3 amplitude, and no correlations were found between N2 latency or P3 amplitude and affect intensity scores in any WM load (all p > 0.05). In conclusion, the lower P3 amplitudes and longer N2 latencies in BPD patients suggested that they might have some dysfunction of neural activities in sub-processing in WM, while impulsiveness and negative affect might not have a close relationship with these deficits.

Genetic and Neuroimaging Features of Personality Disorders: State of the Art

Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.

The Stigma of Personality Disorders

This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.